Healthcare Provider Details

I. General information

NPI: 1033663406
Provider Name (Legal Business Name): PORTA NOVA HOMEMAKER COMPANION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2016
Last Update Date: 11/21/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 N SEMORAN BLVD SUITE 103
ORLANDO FL
32807-3500
US

IV. Provider business mailing address

1320 N SEMORAN BLVD SUITE 103
ORLANDO FL
32807-3500
US

V. Phone/Fax

Practice location:
  • Phone: 407-214-4153
  • Fax: 407-704-4560
Mailing address:
  • Phone: 407-214-4153
  • Fax: 407-704-4560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number StateFL

VIII. Authorized Official

Name: ALBA LINDA PONCE DE LEON
Title or Position: ADMINISTRATOR
Credential:
Phone: 407-595-0529